Hypnotics Flashcards
before hypnotic is prescribed for insomnia, you need to
establish the cause of insomnia and where possible treat underlying factors
be aware of the following - some patients have ………
and others understate their ….. consumption
some patients have unrealistic sleep expectations, and others understate their alcohol consumption which is often the cause of the insomnia
what type of hypnotics are preferable in pt with sleep onset insomnia (difficulty falling asleep), when sedation the following day is undeniable or when prescribing for elderly ?
short acting
what type of hypnotic is indicated in pt with poor sleep maintenance (e.g. early morning waking) that causes daytime effects, when an anxiolytic effect is needed during the day, or when sedation the following day is acceptable
long acting
you are prescribing a BZDPN for a pt who has early morning waking. what type of BZDPN would you prescribe
long acting
Transient insomnia may occur in those who normally sleep well and may be due to extraneous factors e.g. …… (3)
If a hypnotic is indicated, what type and how many?
noise, shift work, and jet lag
one that is rapidly eliminated should be chosen, and only one or two doses should be given.
short term insomnia is usually related to an emotional problem or serious medical illness. it may last ….
few weeks, may recur
short term insomnia is usually related to …
an emotion problem or serious medical illness
in short term insomnia, a hypnotic can be useful but should not be given for more than…
which type of hypnotic is preferred
and how should it be used
3 weeks (pref 1 week)
A short-acting drug is usually appropriate. Intermittent use is desirable with omission of some doses.
does chronic insomnia benefit from hypnotics
rarely
sometimes, chronic insomnia is due to mild dependence caused by ..
injudicious prescribing of hypnotics
common causes of chronic insomnia
Psychiatric disorders such as anxiety, depression, and abuse of drugs and alcohol
sleep disturbance is very common in depressive illness. the following sign is a characteristic one of depression
early wakening
Sleep disturbance is very common in depressive illness and early wakening is often a useful pointer. The underlying psychiatric complaint should be treated, adapting the drug regimen to alleviate insomnia. For example, the following two drugs prescribed for depression will also help to promote sleep if taken at night
clomipramine
mirtazapine
tolerance to the effects of hypnotics develops with …. days of continuous use and long term efficacy cannot be assured
3-14 days
what is a major drawback of long term use …..
withdrawal can cause rebound insomnia and a withdrawal syndrome
Where prolonged administration is unavoidable hypnotics should be discontinued as soon as feasible and the patient warned that sleep may be disturbed for a few days before normal rhythm is re-established; the following sleep disturbance may persist for several weeks
broken sleep with vivid dreams may persist for several weeks.
why should BZDPNs and Z drugs be avoided in elderly
greater risk of becoming ataxic (poor muscle control that causes clumsy movements) and confused
leading to falls and injury
Some anxious patients may benefit from the use of hypnotics during dental procedures such as (2)
….. is preferred when it is important to minimise any residual effect the following day
diazepam, temazepam
Temazepam is preferred when important to minimise any residual effect the following day
Name 2 long acting BZDPNs that are used as hypnotics. Since they are long acting, they may give rise to residual effects on the following day; repeated doses tend to be cumulative
nitrazepam
flurazepam
Name 3 BZDPNs that are short acting and used as hypnotics. They will have little or no hangover effect, however withdrawal phenomena are more common
loprazolam, lormetazepam, temazepam
withdrawal phenomena are more common with …-acting BZDPNs
short
If insomnia is associated with daytime anxiety then the use of a …….-acting benzodiazepine anxiolytic such as ….. given as a single dose at night may effectively treat both symptoms
LONG acting
diazepam
where do the Z drugs act
at the BZDPN receptor
do the Z drugs have a long or short duration of action
short
explain why clomethiazole may be a useful hypnotic for elderly patients
short acting - no hangover effect
however routine admin still undesirable as with all hypnotics
also dependence occurs
name an antihistamine which is on sale to the public for occasional insomnia
promethazine HCl
Some antihistamines such as promethazine hydrochloride are on sale to the public for occasional insomnia. What is its duration of action? and what is the licensing OTC?
Prolonged so often cause drowsiness the following day
For short term use in the treatment of insomnia in adults and as a sedative in children over 16 years of age. Take 25mg or 50mg at night. Max 7 days. Avoid alcohol.
Qt!! Do not use in p or bf.
Why is alcohol a poor hypnotic
diuretic action interferes with sleep during latter part of night
alcohol also disturbs sleep patterns, and so can worsen sleep disorders
Name the organ in the cerebrum that produces the hormone melatonin
pineal
Melatonin - licensed for the following
(3)
Short term treatment of insomnia in adults over 55
Short term treatment of jet lag in adults
Insomnia in patients with learning disabilities and behaviour that challenges [where sleep hygiene measures have been insufficient] (initiated under specialist supervision)
